罕見攝護腺腫瘤:多房性前列腺囊腺瘤

謝育哲、黃冠華

奇美醫學中心 外科部 泌尿科

Rare Prostatic Tumor: Multilocular Prostatic Cystadenoma

Yu-Che Hsieh, Steven K. Huang

Department of Surgery, Division of Urology, Chi Mei Medical Center, Tainan, Taiwan

Case report:

This is a 67 years old male patient without any systemic disease. Voiding difficulty with urinary frequency and nocturia were noted for 6 months. Thus, he came to our OPD for help. PSA was 16.47. After series examination; MRI-prostate showed a large cystic lesion with intra-lesional hematomas, probably from seminal vesicle with mass effect on the urinary bladder and rectum. Size is about 10x 7.8 x8.7cm. Mucinous neoplasms including cystic adenocarcinoma are considered. After discussed with the patient, TRUS- saturation biopsy was performed first. No evidence of prostatic cancer was noted. Thus, Robotic-assisted laparosopic transperitoneal seminal vesiculectomy and Cystoscopy with RP insertion were done. Intra-operative finding showed huge mucinous tumor over pelvis, favor seminal vesicle origin, with much brownish fluid inside about 200cc. However, pathology showed multilocular prostatic cystadenoma. After operation, his general status was stable. Cystography also showed no urine leakage. Thus, he was discharged. At OPD follow-up, improvement of voiding condition without tumor recurrence was noted

Discussion:

A giant multilocular prostatic cystadenoma is an extremely rare benign neoplasm that originates in the prostate glands. Fewer than 30 cases have been reported. This type of tumor is typically located along the midline between the bladder and rectum and identified as a large retroperitoneal mass. A definitive diagnosis before histological examination of a surgical biopsy is very difficult, but preoperative assessment is important for surgical treatment planning. Previous reports of giant multilocular prostatic cystadenomas indicate that surgical treatment varies from tumor debulking to total pelvic exenteration. Giant multilocular prostatic cystadenoma may occur at any age, with reported patient ages ranging from 23 to 80 years at diagnosis. Presenting symptoms are similar to those of benign prostatic hyperplasia and include incomplete voiding and urinary retention. Almost all cases in the literature noted lower urinary symptoms. Enlargement of the mass also causes abdominal distension and gastrointestinal symptoms.

CT and MRI scans of the present giant multilocular prostatic cystadenoma revealed a large retroperitoneal solid mass with multilocular cavities that were compressing adjacent organs, especially the bladder and rectum. Treatment for giant multilocular prostatic cystadenoma is complete surgical excision. Despite its benign nature, incomplete resection can result in recurrence. One recent report found that a gonadotropin-releasing hormone antagonist is effective for recurrent giant multilocular prostatic cystadenoma, and this may represent a new treatment option for patients with more aggressive or recurrent giant multilocular prostatic cystadenoma.

In conclusion, when a retroperitoneal huge lesion with locular cavities fills the pelvis in men, giant multilocular prostatic cystadenoma should be considered as a differential diagnosis.